What is insomnia?

Doctors define insomnia as difficulty falling or staying asleep at least three nights a week for three months or more. This is considered chronic insomnia, experienced by about half of the people with insomnia.

The other half experience one of the disoder’s other forms, most likely short-term insomnia. Short-term insomnia is defined as insomnia that lasts less than three months. Other types of insomnia include sleep-onset insomnia, or difficulty falling asleep, and sleep-maintenance insomnia, or trouble staying asleep.

Sleep specialists also refer to “rebound insomnia,” a type of short-term insomnia that occurs after you stop taking sleep aids. This doesn’t mean the sleep aid was addictive. Rebound insomnia can occur even with non-habit-forming herbal sleep supplements, because the brain forms a psychological dependence on any sleep aid that’s used regularly. That’s why it’s best to try correcting insomnia by improving sleep hygiene and making other lifestyle adjustments before resorting to sleeping pills or supplements of any kind. Rebound insomnia generally causes one to two days of sleep disturbance, but it can worsen chronic insomnia.

Insomnia symptoms

The symptoms of insomnia include tiredness, low energy, forgetfulness, and poor mood. Other insomnia symptoms include:

Health risks of insomnia

Insomnia also negatively impacts decision-making and reaction times, increasing the risk of accidents. People experiencing insomnia are 2.8 more likely to die in a car crash.

What causes insomnia?

Insomnia affects men, women and children throughout life, though people over 65 have a higher risk of developing insomnia. Women have higher rates of insomnia than men, and pregnancy can trigger insomnia in some women, thanks to higher levels of the hormone progesterone, which disrupts sleep patterns.

Healthcare providers use the terms primary insomnia and secondary insomnia to differentiate the causes of insomnia. Primary insomnia is insomnia that isn’t connected to a medication or another medical condition. Secondary insomnia is insomnia that results from the effects of another health condition, illness, or medication.

Research shows a genetic component to insomnia, so if your parents or other immediate relatives experience insomnia, you may be more likely to struggle with sleep. Fatal familial insomnia is an extremely rare inherited neurodegenerative disorder. Symptoms usually begin between age 32 and 62 and include dementia, insomnia, weight loss, abnormally high or low body temperature and panic attacks.

Though insomnia sometimes appears to have no clear cause, some conditions appear to increase the risk of developing insomnia:

Depression and anxiety

Family member with insomnia

Chronic pain

Poor mental health

Low extraversion

Some chronic health conditions can increase the risk of insomnia, including:

Alzheimer’s disease

Parkinson’s disease

Heart disease

Diabetes

Sleep apnea

Restless legs syndrome

Fibromyalgia

Kidney disease

Lung disease

Arthritis

Upper respiratory illness/allergies

Gastrointestinal reflux disease (GERD)

Certain medications can increase the risk of insomnia. Insomnia resulting from medications is referred to as secondary insomnia. These medications include:

Dopamine agonists (including some medications used to treat Parkinson’s)

Anticonvulsants

Niacin

Steroids

Beta agonists

Theophylline

Medications to lower blood pressure

Cold medicines and decongestants

Diuretics

Appetite suppressants

Additionally, using caffeine, nicotine, or alcohol can cause or worsen insomnia.

Related conditions

Insomnia is linked to a number of other health disorders, from heart disease to arthritis. People experiencing insomnia have a significantly increased risk of developing depressive disorder. Chronic pain and increased pain sensitivity are also linked to insomnia.

Some chronic health conditions that can increase the risk of insomnia:

Alzheimer’s disease

Parkinson’s disease

Heart disease

Diabetes

Sleep apnea

Restless legs syndrome

Fibromyalgia

Kidney disease

Lung disease

Arthritis

Gastrointestinal reflux disease (GERD)

Diagnosis and treatment of Insomnia

Insomnia is diagnosed by a combination of a detailed health history and a sleep journal. Keeping a journal of sleep patterns can help your healthcare provider determine which type of insomnia you might have, and better understand how to help you.

Treatment for insomnia can include medication or behavioral strategies, or a combination of the two. Because of the risk for dependence, potential interference with other mediations and the risk of rebound insomnia, behavioral and lifestyle changes are often the first line of treatment for insomnia.

Behavioral treatment for insomnia

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive Behavioral Therapy for Insomnia is talk therapy that helps change unhealthy thought patterns and anxieties that may be interfering with the ability to fall asleep and stay asleep. This type of therapy is proven to be as effective as sleeping pills for treating insomnia, without side effects or risks. It takes place in the office of a trained therapist and occurs over multiple sessions. A typical course of treatment may be four to six sessions over one to two months.

Sleep restriction therapy

Sleep restriction therapy involves establishing a strict bedtime and wake-up time routine and avoiding daytime naps. This type of therapy can be particularly effective for sleep maintenance insomnia.

Lifestyle changes

Many behaviors can affect the ability to fall asleep or stay asleep, including using technology in the last hour before sleep, consuming caffeine too close to bedtime, failing to maintain a consistent sleep-wake schedule, consuming heavy meals before bedtime or exercising too late at night. Sleep specialists generally recommend improving sleep hygiene before trying sleep medications for insomnia or for people who can’t take sleep medications.

Medicines for insomnia

Doctors prescribe a number of medications to treat insomnia. Insomnia medications are generally intended for short-term use (under four weeks).